Reconstruction of ureter with transverse retubularized colon segments

Purpose: We present a technique in which colon segments are reconfigured as substitutes for ureteral defects. Materials and Methods: Via a flank incision a 3 cm. segment was obtained fr om the ascending or descending colon and reconfigured into a well vasculari zed tube. In 2 patients a single retubularized colon segment was interposed into an extensive defect of the upper and mid ureter, respectively. In an additional 2 patients 2 combined anastomosed reconfigured colon segments we re used for pyelo-colo-cutaneostomy. Results: At a followup of 9 to 27 months (mean 15), no complications relate d to the reconfigured colon segments were noted. One patient died of progre ssive disease 9 months postoperatively but with no evidence of ureteral sub stitute malfunction. Conclusions: Reconfigured colon segments may be used successfully to recons truct extensive ureteral defects. Access is via a flank or pararectal incis ion and intraperitoneal surgery is minimal. The colon segments are obtained immediately proximal to the ureteral defect, necessitating little mobiliza tion of the mesenteric pedicle. Metabolic consequences should be absent or low since only minimal amounts of intestine are isolated. In patients with renal insufficiency or a history of irradiation this technique may be super ior to the use of ileum.